What Happens Inside a Dying Mind?

[W]hat makes a person believe that he visited heaven? Is there a way for science to get at what’s really going on? In the April 2015 issue of the Atlantic, Gideon Lichfield mounts an empirical investigation of near-death experiences, concluding that more rigorous research must be pursued to understand what happens in the minds of “experiencers,” as they call themselves. One thing is abundantly clear, though. Near-death experiences are pivotal events in people’s lives. “It’s a catalyst for growth on many different levels—psychologically, emotionally, maybe even physiologically,” says Mitch Liester, a psychiatrist.


 
Complete Article HERE!

Toronto vet helps pets to pass in comforts of home

Home is a pet’s safe space and favourite place. This is where they lived and this is where they should be allowed to die, writes in-hospice veterinarian Faith Banks.

[A]t first, they open the door to their home and greet me with “you have the worst job in the world”, followed by “how do you do this?”

They are pet owners and they are referring to the fact I am a hospice veterinarian. I am at their home because I am a mobile hospice veterinarian. I am at their home to help them say goodbye to their most loved companion, their family dog or cat.

When I enter their home, people often apologize for the dirty dishes still in the sink or the mess on the floor. I am blind to their clutter and I never judge them on the cleanliness of their home. What I do notice are the blankets and pillow on the couch.

You see, when an older pet is no longer able to make it upstairs to the owner’s bed, the owner’s bed gets moved to the family room couch. These are some of the final precious moments owners have with their pet and they don’t want to miss out on any of it by sleeping apart for their last few weeks or days together. It is a slumber of true love.

Goodbye at home is a gift

Being able to say goodbye at home is a gift people can provide to their beloved aging pets. Veterinary Aid in Dying, euthanasia or putting a pet to sleep are all terms for the final act of love pet parents are often called on to do for a pet that is suffering. This suffering may be physical and/or emotional and can deeply affect the owner as well.

From the Greek translation, euthanasia literally means “good death”. Our pets are most deserving of a good death, especially after the unconditional love and dedication they showered upon us during our memorable lives together.

When I began my in-home hospice and palliative care service, my goal was to ensure everyone had the opportunity to allow their pet to pass with dignity and love.

Comfort and privacy

Today, along with three other compassionate veterinarians, we are able to provide this service to pets and their owners in the comfort and privacy of their homes. Being able to provide this personal and meaningful service is an honour and responsibility I don’t take lightly.

Home is where the heart is and home is where the dog is. This is their safe space, their favourite place. This is where they lived and this is where they should be allowed to die.

Euthanasia at home, performed by a skilled veterinarian, ensures our pets are not stressed, are not in pain and have a peaceful, love-filled passing. Something they no doubt deserve, and something we all hope for ourselves.

So now, by the time I leave, “you have the worst job in the world” changes to “what an emotionally rewarding job you have” and “how do you do this?” changes to “thank you for doing this”.

Complete Article HERE!

What ancient cultures teach us about grief, mourning and continuity of life

By and

[A]t this time of the year, Mexican and Mexican-American communities observe “Día de los Muertos” (the Day of the Dead), a three-day celebration that welcomes the dead temporarily back into families.

Festivities begin on the evening of Oct. 31 and culminate on Nov. 2. Spirits of the departed are believed to be able to reenter the world of the living for a few brief moments during these days. Altars are created in homes, where photographs

Altar to the dead in Yucatán, Mexico

and other personal items evocative of the dead are placed. Offerings to the deceased include flowers, incense, images of saints, crucifixes and favorite foods. Family members gather in cemeteries to dine not just among the dead but with them. Similar traditions exist in different cultures with different origins.

As scholars of death and mourning rituals, we believe that Día de los Muertos traditions are most likely connected to feasts observed by the ancient Aztecs. Today, they honor the memory of the dead and celebrate the continuity of generations through loving reunion with those who came before.

As Western societies, particularly the United States, move away from the direct experience of a mourner, the rites and customs of other cultures offer valuable lessons.

Loss of rituals

Funerals were handled in the home well into the 20th century in the U.S. and throughout Europe. Sometimes, stylized and elaborate public deathbed rituals were organized by the dying person in advance of the death event itself. As French historian Philippe Ariès writes, throughout much of the Western world, such death rituals declined during the 18th and 19th centuries.

What emerged instead was a greater fear of death and the dead body. Medical advances extended control over death as the funeral industry took over management of the dead. Increasingly, death became hidden from public view. No longer familiar, death became threatening and horrific.

Today, as various scholars and morticians have observed, many in American culture lack the explicit mourning rituals that help people deal with loss.

Traditions in ancient cultures

In contrast, the mourning traditions of earlier cultures prescribed precise patterns of behavior that facilitated the public expression of grief and provided support for the bereaved. In addition, they emphasized continued maintenance of personal bonds with the dead.

As Ariès explains, during the Middle Ages in Europe, the death event was a public ritual. It involved specific preparations, the presence of family, friends and neighbors, as well as music, food, drinks and games. The social aspect of these customs kept death public and “tame” through the enactment of familiar ceremonies that comforted mourners.

Grief was expressed in an open and unrestrained way that was cathartic and communally shared, very much in contrast with the modern emphasis on controlling one’s emotions and keeping grief private.

In various cultures the outpouring of emotion was not only required but performed ceremonially, in the form of ritualized weeping accompanied by wailing and shrieking. For example, traditions of the “death wail,” which allowed people to cry their grief aloud, have been documented among the ancient Celts. They exist today among various indigenous peoples of Africa, South America, Asia and Australia.


 
In a similar way, the traditional Irish and Scottish practices of “keening,” or loudly wailing for the dead, were vocal expressions of mourning. These emotional forms of sorrow were a powerful way to give voice to the impact of individual loss on the wider community. Mourning was shared and public.

In fact, since antiquity and throughout parts of Europe until recently, professional female mourners were often hired to perform highly emotive laments at funerals.

Such customs functioned within a larger mourning tradition to separate the deceased from the world of the living and symbolize the transition to the afterlife.

Rituals of celebration

Mourning rituals also celebrated the dead through carnival-like revelry. Among the ancient Greeks and Romans, for example, the deceased were honored with lavish feasts and funeral games.

Such practices continue today in many cultures. In Ethiopia, members of the Dorze ethnic community sing and dance before, during and after funerary rites in communal ceremonies meant to defeat death and avenge the deceased.


 
In not too distant Tanzania, the burial traditions of the Nyakyusa people initially focus on wailing but then include feasts. They also require that participants dance and flirt at the funeral, confronting death with an affirmation of life.

Similar assertions of life in the midst of death are expressed in the example of the traditional Irish “merry wake,” a mixture of mourning and celebration that honors the deceased. The African-American “jazz funeral” processions in New Orleans also combine sadness and festivity, as the solemn parade for the deceased transforms into dance, music and a party-like atmosphere.


 
These lively funerals are expressions of sorrow and laughter, communal catharsis and commemoration that honor the life of the departed.

A way to deal with grief

Grief and celebration seem like strange bedfellows at first glance, but both are emotions that overflow. The ritual practices that surround death and mourning as rites of passage help individuals and their communities make sense of loss through a renewed focus on continuity.

By doing things in a culturally defined way – by performing the same acts as ancestors have done – ritual participants engage in venerated traditions to connect with something enduring and eternal. Rituals make boundaries between life and death, the sacred and the profane, memory and experience, permeable. The dead seem less far away and less forgotten. Death itself becomes more natural and familiar.

Funerary festivities such as Day of the Dead create space for this type of contemplation. As we reminisce over our own losses, that is something we could consider.

Complete Article HERE!

How to Help Your Kids Cope With the Loss of the Family Pet

by

[P]ets are part of the family, so it makes sense that losing one is tough on everyone, including our children. A pet’s death may be the first time they’ve ever experienced a real loss, and as a parent, it can be difficult to know how to start a conversation about life, death, and grieving in a way they can understand, but that won’t heighten their sadness.

Last week, we put our 12-year-old dog to sleep five weeks after he was diagnosed with lymphoma. It was a brief but rapidly debilitating illness, and I wondered if my kids would understand that a dog who was quite healthy only two months ago was now gone. Surprisingly, they took it much better than I did. My 3-year-old gave me a hug, then told me, “I don’t know why you’re crying, Mom. Gus was sick, and now he’s in heaven with grandma’s dog. He’s not sad he died. He’s still happy.”

After briefly wondering if my child was a pet psychic, I realized that his logic was pretty sound. While my son would miss our dog, he knew our pup had been suffering, and he was prepared for the death. He had processed the loss faster and more easily than I did precisely because he was a kid. If you’re dealing with the loss of a family pet, here’s how to help your children process their feelings.

  1. Make sure your child understands what death means. Gently make sure that your child understands that their pet’s death means the animal will never be physically present again. Don’t be alarmed if it takes awhile — even years depending on their age — for your child to understand that means that your pet can no longer breathe, feel, or ever be alive again. If the death was sudden or unexpected, explaining why or how your pet died might be important to help your child understand the permanence of the loss. Of course, consider your child’s age and ability to understand and only give them developmentally appropriate information.
  2. Be honest. Telling your child about the death openly and truthfully lets your child know that it’s not bad to talk about death or sad feelings, an important lesson as they will have to process many other losses throughout their lives.
  3. Follow your child’s lead. Sometimes children are better than adults at accepting loss, especially when they’ve known for some time that their pet had a limited life span or was ill. Don’t attempt to make your child’s grief mirror your own, but do validate any emotions that come up as your child goes through the mourning process, and be ready to talk when they have questions. Age-appropriate books like Sally Goes to Heaven and I’ll Always Love You can also help with communication.
  4. Don’t be surprised if your child grieves in doses. Children often spend a little time grieving, then return to playing or another distraction. This normal, necessary behavior prevents them from becoming overwhelmed and makes the early days of grief more bearable for them.
  5. Say a formal goodbye. Consider having a small memorial service where you can all say goodbye, discuss favorite memories, and thank your pet for being part of the family, even if the service is just in your backyard or around the kitchen table.
  6. Find a way to memorialize your pet appropriately. We often don’t realize how constant our pets were in our lives until they’re gone. By making a photo album, turning a collar into a Christmas ornament, or commissioning personalized art work through Etsy, your whole family will have a positive remembrance of your beloved pet for a lifetime.

Complete Article HERE!

Don’t want ‘heroic measures’ as part of your end-of-life care? Have the conversation

intubated patient in hospital, intubatation at intensive care unit room respiratory machine with oxygen ventilation monitor

By Allison Bond

[F]or one month this spring, my job as a senior resident in a large teaching hospital entailed racing around the hospital, managing patients who had rapidly become sicker; I wore running shoes every day. I also led every code, orchestrating a team of doctors, nurses, respiratory therapists, and pharmacists in an effort to resuscitate patients after their hearts had stopped. Some of the very sick patients under my care had do-not-resuscitate orders, but most didn’t. For them, my team and I provided whatever treatments we could.

One night, a colleague asked me to see Mr. S, a middle-aged patient with worrisome vital signs.

Arriving at his bedside, my colleague, Dave, and I saw a sluggish, pale man — he’d been in the hospital for almost a month with life-threatening infections. He answered my questions with brief but cogent statements until he suddenly stopped moving, his eyes staring blankly at the wall. I felt for a pulse. There wasn’t one.

“Call a code blue,” I said as calmly as I could, referring to the all-hands-on-deck alert that a patient’s heart had stopped. Dave began doing chest compressions, pressing rhythmically and firmly on Mr. S’s chest, taking the place of the heart in circulating blood throughout his body. I stood at the foot of the bed as the resuscitation team rushed in. A breathing tube wouldn’t pass down Mr. S’s windpipe, so a surgeon performed a cricothyrotomy, cutting a hole in the throat so we could insert a tube to help him breathe. As we paused chest compressions to check for a pulse, 15 wide-eyed faces looked to me to tell them what to do next. Although most in attendance had been involved in attempts to resuscitate patients before, the adrenaline-fueled brutality universal to codes is nearly impossible to get used to. Mr. S’s heart still wasn’t pumping, so we continued.

A few moments later, his arms flailed, thanks to the blood the chest compressions were sending to his brain and the rest of his body. The intern who had taken over for Dave paused in alarm. Another resident reassured her this simply meant her compressions were strong, and urged her to continue pushing.

After more compressions and injections of medicines to bring up the blood pressure and restart the heart, Mr. S’s began to beat faintly. Stable for the moment, we moved him to the intensive care unit. His prognosis was grave, so his family opted against future resuscitations. Later that day, his heart stopped again — that time forever.

We may have revived Mr. S, at least for a few hours, but I’m not sure we really helped him. Were our actions what he truly wanted?

Most people whose hearts suddenly stop don’t survive. Of the more than 200,000 Americans every year who go into cardiac arrest in the hospital, only about one-quarter make it out of the hospital alive. Of those, nearly 30 percent are seriously disabled.

Doctors often don’t adequately convey these grim outcomes; many patients remain falsely optimistic, tending to overestimate their chances of surviving a cardiac arrest. And few people understand what the resuscitation process truly entails, and how these efforts often lead to a painful, undignified death. Recent research also shows that patients and caregivers tend not to be on the same page when it comes to what level of disability or pain might be acceptable to a patient in the future, including after a code.

There’s got to be a way to close these gaps.

The solution starts with a conversation between doctors and their patients about what the end of life might look like. In an effort to make these discussions more common, Medicare now allows doctors to count such discussions, known as advance care planning, as a topic worthy of a doctor’s visit — and of reimbursement under a new billing code — if patients are open to it. Since this change took effect Jan. 1, 2016, nearly 575,000 patients and 23,000 providers have participated in such reimbursed conversations. Of course, there’s plenty of room for improvement: Although that’s almost twice as many conversations as predicted by the American Medical Association, it’s only 1 percent of all people enrolled in Medicare.

It may seem ridiculous to need to pay doctors to have these conversations. Yet given the myriad demands on doctors’ time, making this conversation reimbursable puts it on equal footing with measuring blood pressure, discussing an irregular heartbeat, and other topics long considered vital parts of a doctor visit. These conversations aren’t simply something that are nice to do; they are an incredibly important part of the way patients live and die.

Yet this initiative faces opposition by lawmakers whose fundamental misunderstanding of advance care planning risks seriously harming patients. One such example is the dangerously misnamed Protecting Life Until Natural Death Act, proposed by Rep. Steve King (R-Iowa) this past January. The bill calls for excluding end-of-life discussions from Medicare reimbursement, discouraging doctors from having these important conversations. That’s a problem because in the American medical system, the default position is to do everything possible to revive a patient unless he or she requests otherwise. And in reality, there’s nothing natural about a death prolonged by painful chest compressions, endless needle sticks, and a breathing tube forced down the throat, especially when such efforts are usually futile. In fact, some experts have proposed changing the term “do not resuscitate” to “allow natural death” to better reflect the realities of end-of-life care.

There’s no doubt heroic measures save some lives — but they aren’t what everyone wants. That’s why end-of-life discussions are essential for protecting patients and empowering them to make clear, well-informed decisions that let doctors do right by them. It’s absolutely vital that we keep these conversations going.

Complete Article HERE!

Here’s what traditional funerals are like in the Philippines

Blindfolded bodies and hanging coffins – the unusual funerals of the Philippines

MANILA, PHILIPPINES – OCTOBER 31: A coffin is placed on a tombstone during a funeral at the Navotas public cemetery on October 31, 2011 in Manila, Philippines. The ‘Day of the Dead (Todos Los Santos), ‘All Saints’ Day,’ and ‘All Souls Day’ are feast days celebrated on the first and second of November each year in Latin cultures around the world during which family and friends of the deceased gather around these days at cemeteries to pray and hold vigils for those who have passed. In the Philippines, family members clean the tombs, leave flowers and often spend the night at the tomb eating and celebrating with loved ones.

By

[H]ere in Blighty, we tend to stick to the same tried and tested funeral traditions.

Save for religious elements, funerals in Glasgow aren’t too different from those in Preston; funerals in Wells are largely the same as funerals in Norwich.

This is not the case in the Philippines.

The country is largely Catholic (recent estimates suggest around 80 per cent) with a smaller demographic of Filipino Muslims. But in the more remote areas, tribal traditions, passed down over centuries, dictate some seemingly unconventional funeral customs that are practiced to this day.

From under-floor burials to hanging coffins, cigarette-smoking corpses to in-tree interment, each rite has the same intent: to offer the dead safe passage to the next life.

Blindfolds and cigarettes

Benguet is a landlocked province in the southern tip of the island of Luzon.

When someone dies here, friends and relatives start to convene at the deceased person’s house.

The body is cleaned, and a few of the men are dispatched to collect bamboo, which they then fashion into a chair – and this is where the body is seated.

Once secured in place with more bamboo and strips of cloth, the body is blindfolded so that the deceased does not have to bear witness to the suffering in the world.

A fire is lit to fend off insects and act as a beacon should the deceased’s spirit wander and be unable to find its way home.

This period lasts for eight days and, as you might expect, the body begins to decay.

This holds no fear for the Benguet people – in fact, they make jokes about the smell, and happily offer alcoholic drinks to the body during the mourning feast.

The night before the funeral, elders give a chanted, oral biography of the deceased and as the body is buried, mourners hit bamboo sticks together in the belief it will help the departed find their way to heaven.

The Benguet’s near neighbours, the people of Tinguian, also seat their dead in a prominent position, with a couple of small discrepancies: the Tinguian dress their deceased in their finest clothes then place a cigarette – which is frequently lit – between their lips.

For the llongot people in the mountains the east of Luzon, being seated is integral to burial, rather than the wake.

Corpses are buried sitting up and women have their hands tied to their feet to prevent their ghosts from roaming.

Home is where the heart is

The Apayao – also referred to as the Isnegs or Isnags – inhabit the area around the north of Luzon.

They live mostly along rivers, in large airy homes that sit atop wooden posts, and when they lose relatives, the custom is to bury them under the kitchen area.

It is a unique practice thought to be a sign of love and affection for the deceased.

A natural approach

Not all Filipino tribes keep their dead at home. Further north, the Caviteño have adopted an approach that returns their loved ones to the earth.

As they near the end of life, people of the Cavite venture into the forest and select a favoured tree.

As they ail, their family builds them a small hut in which the dying person will reside for their final days.

They are not alone: relatives and friends work to hollow out the chosen tree trunk as this is where the newly deceased will be buried.

The Cavite people return the deceased to nature as nature provided for them in life: trees are a source of fruit and fire wood that sustain life, so life is given back to the tree.

Closer to heaven

view of Sagada from the rice fields , a colourful village in north of Luzon island in Philippines South east asia

The people in the Sagada region have an interment ritual that is unusual, even among the Filipino tribes.

For more than 2,000 years the people in this mountainous area have hung their coffins from cliffs – coffins that are carved out of hollow logs by the elderly person about to make imminent use of it.

The theory is that by hanging the coffins in this way, the deceased are closer to heaven.

If a person is too frail or ill, the family makes the coffin on their behalf, and after the death the coffin is taken to a cave or hung to reach aspects of the cliff face, placed close to their ancestors.

Some of the coffins are more than a century old, which makes decay inevitable; the coffins eventually fall but this is part of the fulfillment of the rite.

Tourists are advised not to walk under the coffins, and certainly not to disrespect them by touching, but they they hold a unique beauty and can be observed using binoculars from a safe distance.

Ancient superstition

It may be less intensive, but it is customary for Filipinos to adhere to superstitions, or pamahiin sa patay, most of which are rooted in long-held beliefs.

These must be observed during the wake in order to avoid further deaths and bad luck in the family – and as Filipino wakes can last anything from a few days to a few weeks, this is no easy feat.

The Cebuano people have a long list of superstitions around death. They do not sweep the floor, lest the soul of the deceased be banished from the household.

Mirrors are covered, as it is feared the dead will attempt to show themselves in the reflection.

Mourners should avoid crying onto the glass screen of the casket, in case it impedes the spirit from journeying into the afterlife.

And should you sneeze during the wake, make sure someone pinches you – sneezing invites death but a pinch is meant to ward it off.

In the event of an unjust killing, a chick is placed on top of the coffin to bring justice.

While some of these traditions may seem unusual compared with the practices we have developed in the west, family is central to life and death in the Philippines.

The elderly remain at home until the end of life, which means most die surrounded by those they love – something the UK would do well to replicate.

Funerals are a chance for families to reunite, to reconnect and reinforce familial bonds, and often wakes are extended to accommodate overseas relatives.

Togetherness, family, grief and the comfort of ritual: mountains and oceans may separate us, but maybe we aren’t so different after all.

Complete Article HERE!

How to Give Back to the Earth in Death

Conservation burials are one step beyond green burials, and may set aside a couple of square miles for wildlife a year.

By

[W]hen Matthew Holden’s best friend died last year at the age of 31, it prompted him to think hard on what he would want when his own time came. “What would I want to do with my body when I die?” he asks. “How can I do the best for the world?” After some research, Holden, a mathematician who studies conservation at the University of Queensland in Australia, came across conservation burials.

You may have heard of green burials—funerals in which people eschew formaldehyde-based embalming and metal caskets in favor of more environmentally friendly practices that let the body more easily decompose. Such burials appeal to those who cared about the environment in life, and liked the idea of returning to the Earth in death. “Conservation burial is the next step,” Holden says. In addition to making the burial process itself eco-friendly, conservation burials include interment in a cemetery that’s designed to preserve a parcel of land. People may still visit the cemetery, but it’s maintained as a sort of wilderness area, with small or no headstones, instead of the traditional manicured park. “The goal is to protect native habitat, or restore native habitat for threatened or protected species,” Holden says. In an essay released today in the journal Conservation Letters, he shows just how much space and money would go toward threatened plants and animals if every American chose to have a conservation burial.

The mathematician has found that, given the average burial plot size, conservation burials would set aside two square miles a year for wildlife, if every American chose to have one. (The actual number may be larger because conservation cemeteries tend to leave more space between plots.) Funeral revenues run to an estimated $19 billion annually in the United States. Not all of that money is used to purchase and maintain cemetery space, of course, but the idea of putting even a fraction of that toward land that may help endangered animals and plants is appealing. “Just having that amount of money going to conservation is a lot,” Holden says.

There are few conservation cemeteries in the U.S. The website of the Green Burial Council, which independently certifies various green funeral practices, lists only six. And it’s not known, actually, how much conservation cemeteries aid species. Studies suggest that traditional cemeteries can act as mini green sanctuaries—the historic Weissensee Jewish Cemetery in Berlin, for example, has been found to house 48 species of threatened bats, birds, plants, mosses, and bugs. Could greener practices help burial grounds protect even more species? Holden wants to see biologists undertake studies comparing conservation cemeteries with traditional ones.

Matthew Holden

It’s hard to face death, and different people find different practices comforting. For Holden, it’s clear the idea of giving back helps. In addition to providing homes for endangered animals, he hopes conservation cemeteries could offer a park-like space for visitors, and not just the friends and family of the deceased, either. Imagine a walk in the woods that just happens to be a cemetery. So he’s been trying to get the word out, especially after he quizzed his colleagues in the conservation department at the University of Queensland and found none of them had heard of conservation burials.

“After my friend’s passing I was depressed, and part of the healing process for me was to try and generate some good from such an tragic event in my life,” he says. “It is very much about turning a negative into a positive for me.”

Complete Article HERE!